Psychometric evaluation of the Polish version of the Adherence to Refills and Medications Scale (ARMS) in adults with hypertension

Figures & data

Table 1 Sociodemographic characteristics of participants (n=279)

Female sex, n (%)	166 (59.5)
Age (years), mean ± SD	66.5±11.0
<65 years, n (%)	153 (54.8)
Caucasian race, n (%)	279 (100.0)
Relationship status, n (%)
In a relationship	185 (66.3)
Single	94 (33.7)
Residence, n (%)
Rural	85 (30.5)
Urban	194 (69.5)
Professionally active, n (%)	100 (35.8)
Education, n (%)
None or primary	55 (19.7)
High school	96 (34.4)
College/university	128 (45.9)
Blood pressure (mmHg), n (%)
≤140–159/90–99	193 (69.2)
160–179/100–109	60 (21.5)
≥180/110	26 (9.3)
Frequency of blood-pressure measurement, n (%)
One to three times a day	143 (51.3)
More than once per week	68 (24.4)
Once per week	11 (3.9)
When feeling worse	35 (12.5)
At the physician’s office	22 (7.9)
Patient able to tell how many pills they take daily, n (%)
Yes, five or fewer	98 (35.1)
Yes, more than five	18 (6.5)
No	163 (58.4)
How medication is taken, n (%)
Prepared and given by another person	92 (33.0)
Prepared and taken by the patient	187 (67.0)
Patient reads information leaflets for the prescribed medication, n (%)
Yes, always	88 (31.5)
Yes, sometimes	85 (30.5)
Never	106 (38.0)

Table 2 Reliability analysis for ARMS-12 items in the study group (n=279)

Question*	Participants scores (mean ± SD)	Item–total correlation	Cronbach’s α if item removed
1. How often do you forget to take your medicine?	17.9±8.1	0.807	0.944
2. How often do you decide not to take your medicine?	18.2±8.1	0.866	0.943
3. How often do you forget to get prescriptions for your medicine?	18.2±8.1	0.875	0.942
4. How often do you run out of medicine?	18.2±8.1	0.851	0.943
5. How often do you skip a dose of your medicine before you go to the doctor?	18.1±8.0	0.886	0.942
6. How often do you miss taking your medicine when you feel better?	18.0±7.9	0.877	0.942
7. How often do you miss taking your medicine when you feel worse?	18.3±8.2	0.640	0.950
8. How often do you miss taking your medicine when you are careless?	18.1±8.1	0.889	0.942
9. How often do you change the dose of your medicine to suit your needs?	18.4±8.4	0.556	0.952
10. How often do you forget to take your medicine when you are supposed to take it more than once a day?	18.1±8.0	0.891	0.942
11. How often do you put off refilling your medicines because they cost too much money?	18.1±8.0	0.812	0.944
12. How often do you plan ahead and refill your medicines before they run out?**	17.5±8.3	0.363	0.962

Notes:

** Questions reproduced with permission from Kripalani S, Risser J, Gatti ME, Jacobson TA. Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value Health. 2009;12(1):118–123. Copyright © 2009 Emory University.²¹

* This item was reverse-coded, ie, 1 = always, 2 = most of the time, 3 = sometimes, 4 = never.

Abbreviation: ARMS, Adherence to Refills and Medications Scale.

Table 3 Reliability analysis for individual ARMS-P items in the study group (n=279)

Question*	Adherence
	Low (16–48 points), n=135, mean ± SD	High (8–15 points), n=144, mean ± SD
1. How often do you forget to take your medicine?	2.4±0.8	1.3±0.5
2. How often do you decide not to take your medicine?	2.1±0.9	1.0±0.1
3. How often do you forget to get prescriptions for your medicine?	2.1±1.0	1.0±0.1
4. How often do you run out of medicine?	2.1±0.9	1.0±0.1
5. How often do you skip a dose of your medicine before you go to the doctor?	2.3±0.9	1.0±0.0
6. How often do you miss taking you medicine when you feel better?	2.4±1.1	1.0±0.1
7. How often do you miss taking your medicine when you feel worse?	2.0±1.1	1.0±0.0
8. How often do you miss taking your medicine when you are careless?	2.2±0.9	1.0±0.2
9. How often do you change the dose of your medicines to suit your needs?	1.7±0.9	1.0±0.1
10. How often do you forget to take your medicine when you are supposed to take it more than once a day?	2.3±0.9	1.0±0.2
11. How often do you put off refilling your medicines because they cost too much money?	2.1±1.1	1.1±0.3
12. How often do you plan ahead and refill your medicines before they run out?	2.8±1.1	1.8±1.1

Notes:

* Questions reproduced with permission from Kripalani S, Risser J, Gatti ME, Jacobson TA. Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value Health. 2009;12(1):118–123. Copyright © 2009 Emory University.²¹

Abbreviation: ARMS-P, Adherence to Refills and Medications Scale – Polish.

Table 4 Sociodemographic characteristics of the patients (n=279) broken down by adherence and significance levels

Variable	Adherence score (ARMS)		P-value
	Low	High
Female sex, n (%)	74 (54.8)	92 (63.9)	0.123
Age (years), mean ± SD	68.2±11.0	65.0±10.7	0.017
<65 years, n (%)	48 (35.6)	68 (47.2)	0.048
Caucasian race, n (%)	135 (100.0)	144 (100.0)	1.000
Relationship status, n (%)
In a relationship	87 (64.4)	98 (68.1)	0.524
Single	48 (35.6)	46 (31.9)
Residence, n (%)
Rural	36 (26.7)	49 (34.0)	0.182
Urban	99 (73.3)	95 (66.0)
Professionally active, n (%)	39 (28.9)	61 (42.4)	0.041
Education, n (%)
None or primary	33 (24.5)	22 (15.3)	0.037
High school	50 (37.0)	46 (31.9)
College/university	52 (38.5)	76 (52.8)
Blood pressure (mmHg), n (%)
Normal (≤140/90)	62 (45.9)	131 (91.0)	<0.001
High (≥140/90)	73 (54.1)	13 (9.0)
Frequency of blood-pressure measurement, n (%)
One to three times a day	52 (38.5)	91 (63.2)	<0.001
More than once per week	29 (21.5)	39 (27.1)
Once per week	9 (6.7)	2 (1.4)
When feeling worse	28 (20.7)	7 (4.9)
At the physician’s office	17 (2.6)	5 (3.5)
Patient able to tell how many pills they take daily, n (%)
Yes, five or fewer	31 (23.0)	67 (46.5)	<0.001
Yes, more than five	14 (10.4)	4 (2.8)
No	90 (66.6)	73 (50.7)
How medication is taken, n (%)
Prepared and given by another person	54 (40.0)	38 (26.4)	0.016
Prepared and taken by the patient	81 (60.0)	106 (73.6)
Patient reads information leaflets for the prescribed medication, n (%)
Yes, always	19 (14.1)	69 (47.9)	<0.001
Yes, sometimes	41 (30.4)	44 (30.6)
Never	75 (55.6)	31 (21.5)

Table 5 Factor analysis (varimax-rotated component matrix) for ARMS in the study group (n=279)

Question*	Factor 1	Factor 2
1. How often do you forget to take your medicine?	0.797
2. How often do you decide not to take your medicine?	0.739
3. How often do you forget to get prescriptions for your medicine?	0.879
4. How often do you run out of medicine?	0.878
5. How often do you skip a dose of your medicine before you go to the doctor?	0.775
6. How often do you miss taking you medicine when you feel better?	0.745
7. How often do you miss taking you medicine when you feel worse?		0.746
8. How often do you miss taking your medicine when you are careless?	0.841
9. How often do you change the dose of your medicines to suit your needs?		0.822
10. How often do you forget to take your medicine when you are supposed to take it more than once a day?	0.863
11. How often do you put off refilling your medicines because they cost too much money?	0.823
12. How often do you plan ahead and refill your medicines before they run out?	0.663
Eigenvalue	6.672	2.694
Variance accounted for	55.6%	22.4%

Notes:

* Questions reproduced with permission from Kripalani S, Risser J, Gatti ME, Jacobson TA. Development and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic disease. Value Health. 2009;12(1):118–123. Copyright © 2009 Emory University.²¹

Abbreviation: ARMS, Adherence to Refills and Medications Scale.

Table 6 Adherence scores for the studied group (n=279) in the entire ARMS scale and its domains, with scale internal consistency analysis

Group (n)	ARMS-12 reliability analysis
	ARMS global			Domain 1			Domain 2
	Participants scores (mean ± SD)	α	r	Participants scores (mean ± SD)	α	r	Participants scores (mean ± SD)	α	r
Total (279)	19.7±8.8	0.954	0.670	16.9±7.8	0.958	0.729	2.8±1.5	0.775	0.632
Sex
Female (166)	18.8±8.2	0.952	0.660	16.1±7.3	0.959	0.729	2.7±1.3	0.735	0.581
Male (113)	21.1±9.6	0.955	0.677	18.1±8.3	0.957	0.727	3.0±1.7	0.810	0.681
Age (years)
≤65 (126)	19.3±9.1	0.963	0.724	16.6±8.0	0.967	0.780	2.8±1.6	0.840	0.724
>65 (153)	20.1±8.6	0.946	0.631	17.2±7.6	0.951	0.694	2.9±1.5	0.712	0.552
Residence
Rural (85)	19.8±9.4	0.965	0.727	16.9±8.3	0.972	0.790	2.9±1.5	0.690	0.527
Urban (194)	19.7±8.6	0.949	0.654	16.9±7.6	0.953	0.712	2.8±1.5	0.830	0.710
Relationship status
Single (94)	19.8±8.7	0.949	0.653	16.9±7.6	0.953	0.709	2.9±1.6	0.759	0.612
In a relationship (185)	19.7±8.9	0.956	0.684	16.9±7.9	0.961	0.745	2.8±1.5	0.783	0.644
Professional activity
Active (100)	19.7±9.4	0.965	0.738	17.0±8.4	0.973	0.807	2.7±1.5	0.781	0.641
Not active (178)	19.7±8.5	0.947	0.638	16.8±7.4	0.948	0.685	2.9±1.5	0.785	0.647
Education
Primary (55)	22.4±9.5 19.1±8.6	0.948 0.955	0.652 0.677	19.6±8.8 16.2±7.4	0.965 0.955	0.752 0.720	2.8±1.4 2.8±1.5	0.561 0.820	0.390 0.693
High school/college/university (224)

Notes: Domain 1, adherence to medication taking; domain 2, tendency to change medication dosage arbitrarily.

Abbreviation: ARMS, Adherence to Refills and Medications Scale.

Table 7 Relationship between adherence scores and BP control groups

Adherence level (ARMS)	BP control		Fisher’s exact test (P-value)
	Yes, n (%)	No, n (%)
Poor (>12)	173 (89.6)	86 (100.0)	<0.001
Good (≤12)	20 (10.4)	0

Abbreviations: BP, blood pressure; ARMS, Adherence to Refills and Medications Scale.

KripalaniSRisserJGattiMEJacobsonTADevelopment and evaluation of the Adherence to Refills and Medications Scale (ARMS) among low-literacy patients with chronic diseaseValue Health200912111812319911444

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